U.S. senator raises questions about prescriptions written under Minnesota’s Medicaid program

A prominent U.S. senator is raising concerns about the potential for doctors in Minnesota to abuse the Medicaid health-insurance program by prescribing large numbers of painkillers and other medicines.

In a January letter to state officials, Sen. Charles Grassley, R-Iowa, wrote that he found several “shocking” examples of potential abuse in Minnesota from his review of the prescribing habits of certain physicians.

In one case, the top Minnesota prescriber of the painkiller OxyContin wrote more than twice the number of prescriptions for the drug in 2009 as the state’s No. 2 prescriber, Grassley wrote. It led the senator to question whether the state is providing adequate scrutiny.

“These types of drugs have addictive properties, and the potential for fraud and abuse by prescribers and patients is extremely high,” Grassley wrote in a letter dated Jan. 23. “Mental health drugs continue to be prescribed at astounding rates and pain-management clinics are turning into a hotbed for black market painkillers.”

On Wednesday, the state Department of Human Services released a copy of its written response to Grassley.

The state has referred two cases highlighted by the Grassley investigation to the state Board of Medical Practice for investigation, wrote David Godfrey, medical director of the state’s Medicaid program, in a letter dated Feb. 10. But those referrals predated the Grassley inquiry, according to state officials.

“We share your concern about overprescribing and abuse of these drug categories and continue to look for ways to better monitor and control the use of these therapeutically useful yet extremely dangerous prescription drugs,” Godfrey wrote. His letter did not identify the physicians by name.

Medicaid is a health-insurance program for low-income and disabled people that is jointly funded by states and the federal government. When there are problems with use of the drugs in the Medicaid program, taxpayers are the ones who “pay the price for over-prescription, abuse and fraud,” Grassley wrote in January.

In 2010, Grassley first wrote Medicaid officials in Minnesota and across the country seeking information about the top 10 Medicaid prescribers of OxyContin and seven other drugs for pain management and mental health.

A number of states didn’t respond. But in January, Grassley issued a follow-up letter to Medicaid officials in Minnesota and 32 other states that provided information about what the senator described as “serial prescribers.”

In Minnesota, officials expect to refer other cases to the medical board as a result of the review, Godfrey wrote in the letter released Wednesday. In addition, the state found a case where state Medicaid officials weren’t aware that a prescriber had lost authority from the U.S. Drug Enforcement Agency to prescribe controlled substances.

“When the DEA rescinds prescribing authority from a physician, the state Medicaid program is not notified directly,” Godfrey wrote. “As a result, we have no mechanism to rapidly institute claims edits to prevent payment of controlled substances written by an offending physician.”

Some of the examples highlighted by Grassley in January, however, might have innocent explanations.

The doctor who wrote the most prescriptions for OxyContin in 2011, for example, happened to prescribe a small number of pills per prescription, Godfrey wrote. What’s more, many of the top prescribers of mental health drugs have received specialized training.

“We would be much more concerned if the top prescribers of the antipsychotics did not have specialist training,” Godfrey wrote.